Differential Mental Health Assessment Course Materials

Lecture Notes

This module teaches students how to conduct assessments with older adults while effectively differentiating between medical and psychiatric conditions that have overlapping and interacting symptomology. It focuses on building rapport as an essential component to assessments and on awareness that older adults often buy into the myth that pathology is a normative part of aging. Conducting thorough bio-psycho-social-spiritual assessments are crucial in order to understand the older adult’s overall well-being and functioning, therefore, all older adults should be assessed in at least five broad areas which include: medical information, psychiatric history, functional status, psychosocial history, and spirituality. The module includes: mental status exam, a list of classes of commonly used drugs or medications, indications and side effects. It explores symptoms of mild, moderate and severe depression and the high rate of co-morbidity between depression and chronic conditions such as diabetes, nutritional deficiencies, cancer, vision and hearing loss, cerebrovascular disease, endocrine diseases, neurological diseases, delirium, and dementia.

Also included are teachings related to: complicated grief; acute and/or chronic pain in older adults; alcohol use and older adults; stressing that social workers must recognize that psychiatric and medical symptoms can mimic, overlap, interact, and impact each other; and the necessity of routinely adopting a holistic assessment and treatment framework that takes into account the biological, psychological, social and spiritual components of illness and well-being.

PowerPoint

The PowerPoint with teaching notes explores myths associated with aging, differential assessments which can be complicated by: presence or sensitivity to overlapping and interacting symptoms of mental health and physical problems, stroke or trans ischemic attacks (TIA’s), nutritional or metabolic changes, infections, medications, frequent pain, stigma/lack of awareness associated with mental illness, and the experience of multiple losses. Components of assessments must include: mental status, presenting problems, medical and psychiatric history, family psychiatric history, current medications, substance abuse history, developmental, occupational, and social history, and risk and pain assessments while using cognitive, mental health, alcohol and substance use screening instruments. Lists of common medications that can produce psychiatric symptoms in older adults are given. Assessment criteria are given for depression, delirium and dementia, and pharmacology. Gender differences, psychosocial risk factors, complicated grief, impact of pain on functioning plus treatment options and alcohol use are addressed.

Case Studies

Three case studies are presented: 1) An older woman with myeloma and “forgetfulness” 2) An older woman with diabetes showing sings of dementia and 3) An older African American male with diabetes suffering from complicated grief.

Teaching Activities

Contains various teaching activities related to: progressive case studies; role-play interviewing; creating assessment tools for use with older adults; interviewing older adults; diversity assignment; family interview; creating an instrument to be used in gathering information; write a paper describing, comparing and contrasting environment of independent living facilities: assisted living facility, nursing home, and hospital; shadowing a doctor or nurse specializing in geriatrics; facilitating an older adult focus group/panel in class; researching a social policy affecting older adults; and reflecting upon how older adults are portrayed in the media.

Web Site Resources

Lists web resources related to older adults and general information, health/mental health issues in aging, differential diagnosis, cultural competencies, and research and education in gerontology.

Bibliography

Contains an extensive reference list for differential diagnosis in older adults.

Course Integration Outlines

Describes options of how to integrate material into specific courses for working with older adults that include: End of Life Care and Social Work Practice on an Inter-professional Team; Pharmacology in Social Work Practice; Clinical Diagnosis and Social Work Practice; Complementary and Alternative Approaches to Health Care; Health and Mental Health Policy; Social Work Practice in the Health Field; Social Work Practice and Mental Health; and Health and Human Behavior.

Screening Tools for Differential Diagnosis in Older Adults

Screening tools include the Geriatric Depression Scale (GDS): Short Form and the references to: The Mini Mental State Exam (Cognitive Impairment), The Confusion Assessment method (Delirium), The Inventory of Complicated Grief, and The Mini-Cog.